Professional perspectives on service user and carer involvement in mental health care planning: A qualitative study

Background Involving users/carers in mental health care-planning is central to international policy initiatives yet users frequently report feeling excluded from the care planning process. Rigorous explorations of mental health professionals’ experiences of care planning are lacking, limiting our understanding of this important translational gap. Objectives To explore professional perceptions of delivering collaborative mental health care-planning and involving service users and carers in their care. Design Qualitative interviews and focus groups with data combined and subjected to framework analysis. Setting UK secondary care mental health services. Participants 51 multi-disciplinary professionals involved in care planning and recruited via study advertisements. Results Emergent themes identified care-planning as a meaningful platform for user/carer involvement but revealed philosophical tensions between user involvement and professional accountability. Professionals emphasised their individual, relational skills as a core facilitator of involvement, highlighting some important deficiencies in conventional staff training programmes. Conclusions Although internationally accepted on philosophical grounds, user-involved care-planning is poorly defined and lacks effective implementation support. Its full realisation demands greater recognition of both the historical and contemporary contexts in which statutory mental healthcare occurs.

[1]  Helen Lester,et al.  Encouraging user involvement in mental health services , 2005 .

[2]  Graham R. Gibbs,et al.  Analyzing Qualitative Data , 2014 .

[3]  E. Peck,et al.  Information, consultation or control: User involvement in mental health services in England at the turn of the century. , 2002 .

[4]  L. Gask,et al.  Consultant psychiatrists’ experiences of and attitudes towards shared decision making in antipsychotic prescribing, a qualitative study , 2014, BMC Psychiatry.

[5]  G. Thornicroft,et al.  Effect of joint crisis plans on use of compulsory treatment in psychiatry: single blind randomised controlled trial , 2004, BMJ : British Medical Journal.

[6]  M. Roberts Service user involvement and the restrictive sense of psychiatric categories: the challenge facing mental health nurses. , 2010, Journal of psychiatric and mental health nursing.

[7]  M. King,et al.  Advance directives for patients compulsorily admitted to hospital with serious mental disorders: Directive content and feedback from patients and professionals , 2004 .

[8]  P. Bee,et al.  Systematic synthesis of barriers and facilitators to service user-led care planning , 2015, British Journal of Psychiatry.

[9]  P. Campbell The role of users of psychiatric services in service development — influence not power , 2001 .

[10]  P. Bee,et al.  Service user views and expectations of UK-registered mental health nurses: a systematic review of empirical research. , 2008, International journal of nursing studies.

[11]  Graham Thornicroft,et al.  Growing recognition of the importance of service user involvement in mental health service planning and evaluation , 2005, Epidemiologia e Psichiatria Sociale.

[12]  R. McCabe,et al.  Trust, choice and power in mental health care: Experiences of patients with psychosis , 2012, The International journal of social psychiatry.

[13]  L. Del Piccolo,et al.  Involving patients in decisions during psychiatric consultations , 2008, British Journal of Psychiatry.

[14]  P. Tyrer,et al.  User involvement in the planning and delivery of mental health services: a cross‐sectional survey of service users and providers , 2003, Acta psychiatrica Scandinavica.

[15]  Christine Furber,et al.  Framework analysis: a method for analysing qualitative data , 2010 .

[16]  L. Lewis User Involvement in Mental Health Services: A Case of Power over Discourse , 2014 .

[17]  G. McDermott,et al.  The Care Programme Approach: A patient perspective , 1998, Nursing times.

[18]  G. Thornicroft,et al.  Views of service users and providers on joint crisis plans , 2009, Social Psychiatry and Psychiatric Epidemiology.

[19]  P. Crawford,et al.  Service user involvement in care planning: the mental health nurse's perspective. , 2000, Journal of psychiatric and mental health nursing.

[20]  G. Hickey,et al.  Exploring the concept of user involvement in mental health through a participation continuum. , 1998, Journal of clinical nursing.

[21]  A. Summers Involving users in the development of mental health services: A study of psychiatrists' views , 2003 .

[22]  R. Bowl Involving service users in mental health services: Social Services Departments and the National Health Service and Community Care Act 1990 , 1996 .

[23]  Michael Killoran Ross,et al.  User Involvement in Mental Health: Time to Face up to the Challenges of Meaningful Involvement? , 2006 .

[24]  A. House,et al.  Involving users in the delivery and evaluation of mental health services: systematic review , 2002, BMJ : British Medical Journal.

[25]  L. Spencer,et al.  Qualitative data analysis for applied policy research , 2002 .

[26]  J. Atkinson,et al.  Models of advance directives in mental health care: , 2004, Social psychiatry and psychiatric epidemiology.

[27]  M. Dixon-Woods Using framework-based synthesis for conducting reviews of qualitative studies , 2011, BMC medicine.

[28]  G. Szmukler Ethics in Community Psychiatry∗ , 1999 .